title: Risk of choroidal neovascularization among the uveitides.
abstract: OBJECTIVE
  To evaluate the risk, risk factors, and visual impact of choroidal neovascularization (CNV) in uveitis cases.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Standardized medical record review at 5 tertiary centers.
  
  
  RESULTS
  Among 15,137 uveitic eyes (8868 patients), CNV was rare in the cases of anterior or intermediate uveitis. Among the 4041 eyes (2307 patients) with posterior uveitis or panuveitis, 81 (2.0%) had CNV at presentation. Risk factors included posterior uveitis in general and specific uveitis syndromes affecting the outer retina-retinal pigment epithelium-choroid interface. Among the 2364 eyes (1357 patients) with posterior uveitis or panuveitis and free of CNV at the time of cohort entry, the cumulative 2-year incidence of CNV was 2.7% (95% confidence interval [CI], 1.8% to 3.5%). Risk factors for incident CNV included currently active inflammation (adjusted hazard ratio [aHR], 2.13; 95% CI, 1.26 to 3.60), preretinal neovascularization (aHR, 3.19; 95% CI, 1.30 to 7.80), and prior diagnosis of CNV in the contralateral eye (aHR, 5.79; 95% CI, 2.77 to 12.09). Among specific syndromes, the incidence was greater in Vogt-Koyanagi-Harada syndrome (aHR, 3.37; 95% CI, 1.52 to 7.46) and punctate inner choroiditis (aHR, 8.67; 95% CI, 2.83 to 26.54). Incident CNV was associated with a 2-line loss of visual acuity (+0.19 logarithm of the minimal angle of resolution units; 95% CI, 0.079 to 0.29) from the preceding visit.
  
  
  CONCLUSIONS
  CNV is an uncommon complication of uveitis associated with visual impairment that occurs more commonly in forms affecting the outer retina-retinal pigment epithelium-choroid interface, during periods of inflammatory activity, in association with preretinal neovascularization, and in second eyes of patients with unilateral CNV. Because CNV is treatable, a systematic approach to early detection in high-risk patients may be appropriate.
authors.affiliation: The Scheie Eye Institute, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Sally L
authors.initials: SL
authors.lastname: Baxter
authors.affiliation: Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Maxwell
authors.initials: M
authors.lastname: Pistilli
authors.affiliation: Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts; Vasan Eye Care Hospital, Belgaum, Karnataka, India.
authors.forename: Siddharth S
authors.initials: SS
authors.lastname: Pujari
authors.affiliation: Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon.
authors.forename: Teresa L
authors.initials: TL
authors.lastname: Liesegang
authors.affiliation: Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon; Department of Medicine, Oregon Health and Science University, Portland, Oregon; Portland Veterans Affairs Medical Center, Portland, Oregon.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Suhler
authors.affiliation: Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Thorne
authors.affiliation: Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
authors.forename: C Stephen
authors.initials: CS
authors.lastname: Foster
authors.affiliation: Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Ophthalmology, The Icahn School of Medicine at Mount Sinai, New York, New York; Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Jabs
authors.affiliation: Laboratory of Immunology, National Eye Institute, Bethesda, Maryland; Johnson & Johnson, New Brunswick, New Jersey.
authors.forename: Grace A
authors.initials: GA
authors.lastname: Levy-Clarke
authors.affiliation: Laboratory of Immunology, National Eye Institute, Bethesda, Maryland.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Nussenblatt
authors.affiliation: Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon; Department of Medicine, Oregon Health and Science University, Portland, Oregon; Devers Eye Institute, Legacy Health Systems, Portland, Oregon.
authors.forename: James T
authors.initials: JT
authors.lastname: Rosenbaum
authors.affiliation: The Scheie Eye Institute, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: john.kempen@uphs.upenn.edu.
authors.forename: John H
authors.initials: JH
authors.lastname: Kempen
mesh_terms: D000328:Adult; D020256:Choroidal Neovascularization / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D016017:Odds Ratio; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014605:Uveitis / Q000145:classification / Q000453:epidemiology*; D014786:Vision Disorders / Q000175:diagnosis / Q000453:epidemiology*; D014792:Visual Acuity / Q000502:physiology